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The Supreme Court heard 65 cases this term, but waited until the very end of the term to issue its ruling in the case regarding the Patient Protection and Affordable Care Act, more popularly known as Obamacare.

The main issue was the constitutionality of the “individual mandate” that every American not covered by Medicaid, Medicare, or health insurance must purchase health insurance by January 1, 2014, or pay a penalty of $95 or 1 percent of one’s income, whichever is greater. The penalty rises to $695 or 2.5 percent of one’s income in 2016.

The Court did not rule that the “individual mandate” was constitutional because Congress has power under the Commerce Clause to require that everyone purchase health insurance (the government’s primary argument). Rather, it ruled that that the “individual mandate” was constitutional because Congress has power to impose a tax on those who refuse to purchase health insurance (the government’s alternative argument).

According to Chief Justice John Roberts, who wrote the opinion in the 5-4 decision,

The Affordable Care Act is constitutional in part and unconstitutional in part. The individual mandate cannot be upheld as an exercise of Congress’s power under the Commerce Clause. That Clause authorizes Congress to regulate interstate commerce, not to order individuals to engage in it. In this case, however, it is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance. Such legislation is within Congress’s power to tax.Congress may tax and spend. This grant gives the Federal Government considerable influence even in areas where it cannot directly regulate. The Federal Government may enact a tax on an activity that it cannot authorize, forbid, or otherwise control.

But whether the “individual mandate” was ruled unconstitutional or not, socialized medicine is here to stay.

The Patient Protection and Affordable Care Act (PPACA) was signed into law by Barack Obama on March 23, 2010. It was one of the most controversial and partisan pieces of legislation in history, with no Republican in either house of Congress voting in favor of the massive 2,407-page bill (H.R. 3590 [PDF]).

Aside from the mandate that all Americans must be covered by health insurance, the onerous provisions of the PPACA include an expansion of Medicaid eligibility, the prohibition of annual and lifetime coverage caps, the elimination of co-payments and deductibles for selected health-insurance benefits, guaranteed issue of insurance policies without regard to preexisting conditions, federal subsidies for the purchase of health insurance, a penalty on employers with more than 50 employees who do not offer health insurance to full-time workers, maximum annual deductibles, more arcane insurance regulations, an increase in the Medicare tax on the “rich,” and a tax on indoor tanning services.

Although Republicans have vowed to repeal the whole of Obamacare since the day it was passed, the Supreme Court’s ruling has energized their campaign to repeal the legislation.

“Today’s ruling underscores the urgency of repealing this harmful law in its entirety,” said House Speaker John Boehner. “Republicans stand ready to work with a president who will listen to the people and will not repeat the mistakes that gave our country Obamacare.”

Senate Republican leader Mitch McConnell said in a statement, “Today’s decision makes one thing clear: Congress must act to repeal this misguided law. Obamacare has not only limited choices and increased health-care costs for American families, it has made it harder for American businesses to hire.”

House Majority Leader Eric Cantor called the Court’s decision a “crushing blow” to patients and promised that the House would once again vote to repeal the law. He has set a date of July 11 for what will be a largely symbolic vote, since the Democrats control the Senate.

But even if Obamacare had been judged unconstitutional in its entirety (something that wasn’t even under consideration), socialized medicine would still be here to stay.

First of all, Republicans never reverse the bad policies of Democrats. That has been true since the Republican-controlled 83rd Congress of 1953–1955 under the Republican president Dwight Eisenhower. If ever Franklin Roosevelt’s New Deal could have been repealed and the government restored to its pre–New Deal levels that was the time.

The Republicans didn’t control the Congress again until midway into Bill Clinton’s first term. Did they vote to repeal any egregious legislation passed during the previous 40 years? Of course not. They just whined and complained about needing a Republican president in the White House to complete the Republican Revolution. And what happened when they got their Republican president? The disastrous presidency of George W. Bush.

Second, Republicans usually enact more bad policies of their own. They support legislation that is expensive, intrusive, unconstitutional, and socialistic — when it is their own. Back in 2003 the Republicans had their own version of health-care reform: the Medicare Prescription Drug, Improvement, and Modernization Act. This expansion of the welfare state that would shock even Lyndon Johnson was instituted by a Republican-controlled Congress and signed into law by a Republican president. Only 25 Republicans in the House and 9 Republicans in the Senate voted against Bushcare in 2003.

Former Republican presidential candidate Newt Gingrich, although no longer a member of Congress at the time, was a high-profile supporter of Bushcare, writing op-eds and giving interviews in which he argued that it was good legislation.

And of course, who can forget that before every presidential election we are told that we need to elect a Republican president so that he can appoint conservatives to the Supreme Court. Well, Americans elected George W. Bush in 2000 and he nominated John Roberts — the savior of Obamacare — to be the Chief Justice of the United States in 2005. That really turned out well.

Third, in spite of their opposition to Obamacare, Republicans are big supporters of socialized medicine. During the debate over health care early in the Clinton administration, when Democrats proposed mandating that employers provide health insurance, some Republicans countered with a proposal to mandate that individuals purchase health insurance. And what was Romneycare but Obamacare on the state level?

Republicans likewise support Medicare, Medicaid, and SCHIP. They may not believe in the federal government’s forcing Americans to purchase health insurance for themselves, but they do believe in forcing some Americans to pay for the health insurance or health care of other Americans through Medicare, Medicaid, and SCHIP.

The State Children’s Health Insurance Program (SCHIP), which provides federally funded health insurance to children in families with incomes too high to qualify for Medicaid, was actually created by a Republican-controlled Congress in 1997. The program was reauthorized without a whimper under Bush and has been criticized by some Republicans only since Obama became president.

Medicaid is government-funded health care for the poor. It is a joint federal-state program that is administered by the states. No attempt was made to eliminate or severely cut back the program when Republicans controlled the Congress for six years under Clinton and for more than four years under Bush.

Medicare is government-funded health care for those 65 and over or those who are permanently disabled. In their “Pledge to America,” Republicans propose to “support Medicare for seniors,” and “protect our entitlement programs for today’s seniors and future generations.” They actually criticized Obamacare for supposedly cutting Medicare. “Keep your government hands off my Medicare” was a sign held up by some protesting Obamacare during the debates over the health-care bill. Polls at the time showed that even Tea Party conservatives opposed cutting Medicare and Medicaid to deal with the federal budget deficit.

Fourth, even though Republicans say they believe in smaller government, less intrusive government, less government regulation, individual liberty, and the free market, they believe nothing of the kind when it comes to the subject of medicine (and very little else).

The number-two Republican in the House, Eric Cantor, likes some aspects of Obamacare:

We too don’t want to accept any insurance company’s denial of someone and coverage for that person because he or she might have a pre-existing condition. Likewise we want to make sure that someone of your age has the ability to access affordable care if it’s under your parent’s plan or elsewhere.

That is, Cantor wants to use the heavy hand of government to force health insurers to do business with people the government tells them to and to keep doing business with others until they reach a certain age that the government decrees.

The House Republican “Pledge” maintains,

Health care should be accessible for all, regardless of pre-existing conditions or past illnesses. We will expand state high-risk pools, reinsurance programs and reduce the cost of coverage. We will make it illegal for an insurance company to deny coverage to someone with prior coverage on the basis of a pre-existing condition, eliminate annual and lifetime spending caps, and prevent insurers from dropping your coverage just because you get sick.

The Republican argument against Obamacare was never about real medical freedom. The Supreme Court case on the “individual mandate” was never about a free market in health care. Conservatives were not challenging medical licensing laws, the FDA, the Department of Health and Human Services, the National Institutes of Health, Medicare, Medicaid, SCHIP, restrictions on the sale of medical devices, federal grants for medical research, federal funding of clinical trials, special privileges for the AMA or Big Pharma, federal nutrition guidelines, vaccination mandates, restrictions on organ sales,HIV/AIDS-prevention initiatives, or federal regulation of hospitals, physicians, and health insurance.

Former House Speaker Nancy Pelosi has said that “the power of Congress to regulate health care is essentially unlimited.” Although that shouldn’t be the case, that is exactly the situation we are in. It is true with or without the “individual mandate” or the whole of Obamacare. And it is true no matter which party is in control of the Congress. Socialized medicine is here to stay.

Reading List

Prepared by Richard M. Ebeling

Austrian economics is a distinctive approach to the discipline of economics that analyzes market forces without ever losing sight of the logic of individual human action. Two of the major Austrian economists in the 20th century have been Friedrich A. Hayek, who won the Nobel Prize in Economics, and Ludwig von Mises. Posted below is an Austrian Economics reading list prepared by Richard M. Ebeling, economics professor at Northwood University in Midland and former president of the Foundation for Economic Education and vice president of academic affairs at FFF.